Surgical Procedures ExplainedOctober 21, 2020
A short glossary of common surgical procedures performed at Ethos Veterinary Health hospitals follows. This is by no means an exhaustive list and additional content is linked throughout. We hope this resource will be helpful as you navigate the next steps in the care of your pet’s condition.
Herniated Disc Repair – Neurosurgery
Discs in your pet’s spine can become weak with age or trauma. They can rupture, or herniate, causing a portion of the disc to protrude upward and place pressure on the spinal cord. This pressure creates symptoms such as weakness and/or dragging of the legs, pain, loss of control of urination, and a hunched/arched back. Small breed dogs, such as Dachshunds and Cocker Spaniels, are most commonly affected by disc disease. Typically, symptoms will develop suddenly if your pet has a traumatic occurrence, such as jumping off of a couch. Symptoms can progress to paralysis if not treated promptly. Medical management, such as strict rest and steroids, is usually started first before considering surgical treatment, depending on how severe your pet’s symptoms are. If your pet is not walking, treat it as an emergency, and take your pet to a veterinarian immediately.
If surgery is recommended, a myelogram or CT scan is performed to diagnose where the herniated disc is located. Pets are usually in hospital 1-2 days after surgery. Patience and time is required after surgery, as it may take 3 months before your pet starts to walk. A neurologic evaluation by a surgeon or neurologist before considering surgery will help determine how well your pet may do in the recovery period.
Laryngeal paralysis occurs when the muscles that hold the airway open become paralyzed and collapse, causing difficulty breathing. This disease is most common in older, large breed dogs. Your pet may have symptoms for a long period of time such as coughing, change of bark, tiring easily, and sometimes collapse. Most pet’s symptoms will progressively worsen until surgery becomes necessary. To correctly diagnosis laryngeal paralysis, the surgeon must perform a laryngeal exam under sedation. This surgery can be very successful and provide your pet with relief and the ability to live a happy, active life.
OCD (Osteochondrosis dessicans)
Osteochondrosis dessicans (OCD) is a condition of abnormal cartilage growth seen in rapidly growing dogs. Labrador retrievers, Rottweilers, German shepherds, and other large /giant breed dogs are most commonly affected. Most dogs are between 5-7 months of age when signs of lameness occur.
The most commonly affected joint is the shoulder followed by the elbow, ankle (hock), and knee (stifle). X-rays of the affected joint reveal a flattened area of the bone, which corresponds to the defect left by the dead cartilage.
Treatment with anti-inflammatory drugs alone is usually not successful and surgery is generally required. The goals of surgery are to remove any loose cartilage and encourage filling of the defect with new healthier tissue.
Cruciate (Knee) and Hip Surgical Procedures:
CCL (Cranial Cruciate Ligament) Injuries
A cranial cruciate ligament rupture (CCL) is the most common orthopedic injury in dogs. It occurs when a ligament in the knee joint tears resulting in either partial or complete joint instability, pain, and lameness. Cruciate ligament ruptures can be acute (sudden onset caused by trauma) or chronic (degenerative changes in the ligament causing an unstable joint over time).
CCL injuries can occur in cats, but are not as common as in dogs. Most pets experience symptoms such as lameness on and off or holding the leg up off the ground. In acute injuries, your pet may be 3-legged and painful initially; however, most pets start to feel better after a few days of rest and pain medication and are able to walk around on three legs. Recommended treatment of a CCL rupture is surgery, although small breeds (weighing less than 30 lbs) can sometimes do well with medical management.
Extracapuslar stabilization for CCL
Extracapuslar stabilization is another type of surgery performed to treat stifles with torn cruciate ligament injuries. This procedure is a more traditional type of surgery and has been practiced for years. It is recommended on smaller dogs which have too small of bones to be a candidate for TPLO surgery. During the surgery, the surgeon stabilizes the stifle joint by replacing the torn ligament with an artificial ligament made of heavy suture material. Recovery time is generally 3 months of strict rest, followed by 6-8 weeks of rehabilitation. This is surgery that can also be performed on large breed dogs in cases where TPLO surgery is not an option.
Femoral Head Ostectomy (FHO)/Femoral Head and Neck Excision (FHNE)
A Femoral Head Ostectomy (FHO), also called a Femoral Head and Neck Excision (FHNE), is considered a salvage procedure. This means that it usually is performed after osteoarthritis has become so severe in the dog’s hips, that it limits a dog’s activity or makes the dog constantly uncomfortable.
It is the presence of the osteoarthritis and bone-on-bone contact between the femoral head and acetabulum that results in pain. In this procedure, the head and neck of the femur are removed and the limb becomes reliant on muscles and fibrous scar tissue for support.
Patients undergoing an FHO/FHNE will never have the function of a normal hip joint and will always be somewhat limited in activity, but this procedure can greatly reduce pain, and often results in improved function compared to the arthritic joint.
TPLO (Tibial Plateau Leveling Osteotomy)
A Tibial Plateau Leveling Osteotomy (TPLO) is a revolutionary new technique that is performed by a surgeon for the repair of a torn cranial cruciate ligament in a dog’s knee.
Rupture of the cranial cruciate ligament is one of the most common orthopedic abnormalities that occur in dogs. Untreated, this condition can lead to severe, even crippling arthritis of the knee. This procedure is highly recommended for dogs over 40 lbs. that could return to a high-activity or performance lifestyle and for young dogs that will depend on their repair to minimize arthritis throughout their lifetime.
TPO (Triple Osteotomy of the Pelvis)
Triple Osteotomy of the Pelvis (TPO), is a surgery for treating hip dysplasia. The word osteotomy means to cut bone. The purpose of the surgery is to set the ball (femoral head) into the socket (acetabulum). This is done by cutting the bone in three places and rotating the pelvis so the acetabulum rests securely over the femoral head. Once the bone is cut, it is held in place with a stainless steel plate and screws or a combination of screws and wire. It is not necessary to remove the plates, screws, or wires.
Total Hip Replacement (THR)
THR involves implantation of a prosthetic hip in a similar fashion as is done in humans and has been well – established in veterinary medicine since the 1970s. Both “cemented” and “cementless” options are available for dogs and your surgeon will discuss which would be best for your pet. The availability of many different implant sizes makes this the best option for most dogs with severe signs of hip problems. Often, only one hip needs to be replaced to achieve acceptable function. Full recovery from THR takes approximately eight weeks with most dogs able to walk on the affected leg the day after surgery. The success rate of THR is excellent with 90-95% of dogs able to have normal use of the affected limb after surgery.
Minimally Invasive Surgery:
Minimally invasive surgery is frequently used in human medicine. Over the last decade it has transitioned over to veterinary medicine. Small incisions are made to allow insertion of a camera and surgical tools. The surgery is performed using hand held control devices and by visualizing the area in question on a computer monitor. The benefits of minimally invasive surgery include faster recovery and quicker return to normal function. Many orthopedic and soft tissue procedures can be performed using these state-of the-art techniques:
- Arthroscopy is a minimally invasive diagnostic and surgical procedure that allows our surgeons to visualize, diagnose and treat problems inside a joint. Hip, knee, shoulder, and elbow are joints that commonly require arthroscopy. This procedure uses a small, rigid, lighted optic tube (arthroscope), which is inserted into the joint through a small incision. Images of the inside of the joint are then viewed on a television monitor. There are many advantages to arthroscopy-assisted surgeries including improved visualization of the joint structures, minimally invasive technique and shortened procedure times compared to conventional surgery.
- Laparoscopy allows our surgeons to perform a variety of soft tissue surgeries. Such procedures include: ovariohysterectomy or ovariectomy, gastropexy, cryptorchid castration, and organ biopsies.
- Thoracoscopy is a minimally invasive technique that allows our surgeons to visualize the chest cavity without the need to separate the ribs. Procedures that can be performed thoracoscopically include lung biopsy, partial lung lobectomy, pericardal window and subtotal pericardiectomy.